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Company Information

Sales & Use Tax Certificate

Personal Guarantee

Review

Signature Agreement

         

 

Online Customer Application - Company Information

* denotes a required field

If you are an existing customer, enter your customer number:

 

Please select the appropriate business unit:*

Comvox Systems      Comvox Solutions      Comvox Hospitality
ComvoxSystems.net       Comvox.net       

 



 

 

 



 



 



How did you hear about us?*

Magazine: 

Sales Rep:

Other:

Requested Credit Limit :*

Terms Requested :*

 

Company or Corporate Name (Exact Legal Name):*

Doing Business As:*
Same as Company



Telephone Number:*

      Fax Number:  

Billing Address:*

  City :*     State:*    Zip Code:* 

Shipping Address:*
Same as Billing

  City :*     State:*    Zip Code:* 


Your Business is a:*

LLC

C Corp

S Corp

Partnership

Proprietor

FEIN#:*

 Year Started:*   State of Incorporation:* 

Public Company:*

Yes

No

 Ticker Symbol:*  

Company Website:

Are you a:*

Subsidiary

Division

None

Parent Company Name:*

Address:*

  City:*    State:*    Zip Code:* 

A/P Contact:

   Email:      Phone:      Fax:  

Name of Controller:

   Email:      Phone:      Fax:  

 

 

Has this firm ever filed for bankruptcy?*  

Yes

No

If yes, please explain:*

DUNs #:

Do you require a purchase order number before we accept an order?*

Yes

No

 

Ownership:

Principal

Partner

Proprietor

  

Name:

Home Address:

  City:    State:    Zip Code: 

Email Address:

    Home Phone:       Social Security Number:   

 

     

 

 

 


 

Company Information

Sales & Use Tax Certificate

Personal Guarantee

Review

Signature Agreement

         

 

Online Customer Application - Sales and Use Tax Certificate (Multijurisdicton)

* denotes a required field

 

The below-listed states have indicated that this form of certificate is acceptable, subject the notes and instructions found here.  The issuer and recipient have the responsibility of determining the proper use of this certificate under applicable laws in each state, as these may change from time to time.


I certify that:

   

Purchaser's Firm Name:*

   

Purchaser's Firm Address:*

   City:*      State:*      Zip:*   

   


is engaged as a registered:*


             


and is registered with the below listed states and cities within which Comvox Systems Inc. and its divisons ("Comvox Systems") would deliver purchases to us and that any such purchases are for wholesale, resale, ingredients or components of a new product or service to be resold, leased, or rented in the normal course of business.  We are in the business of wholesaling, retailing, manufacturing, leasing (renting) the following:

Description of Business:*

General description of tangible property or taxable services to be purchased from Comvox Systems whose corporate headquarters are located at 5570-401 Florida Mining Blvd S, Jacksonville FL 32257-3256:*

 

 

State

State Registration, Seller's Permit, or ID Number of Purchaser

 

State

State Registration, Seller's Permit, or ID Number of Purchaser

AL2

 

NE14

AR

 

NV

AZ22

 

NJ

CA3

*State Form Required
CA State Form (BOE-230)

 

NM1,15

CO1

 

NY

NY Form (ST-120) 
*If you have no nexus in NY State, please fill out part 2

CT4

 

NC25

DC5

 

ND

FL

*State Form Required
*We will need a copy of FL DR-13

 

OH26

GA6

 

OK16

HI1,7

 

PA27

*State Form Required
PA State Form (REV-1220 AS)

ID

 

RI17

IL1,8

 

SC

IA

 

SD18

KS

 

TN

*State Form Required
TN State Form (RV-F1300701)

KY24

 

TX19

ME9

 

UT

MD10

 

VT

MI11

 

WA20

MN12

 

WI21

MO13

 

 

 

OTHER STATE: 
OTHER State's Registration, Seller's Permit, or ID Number: 

 

 

The undersigned certifies that if any property or service so purchased tax free is used or consumed by the purchaser's firm as to make it subject to a Sales or Use Tax we will pay the tax due directly to the proper taxing authority when state law so provides or inform the seller for added tax billing.  This certificate shall be a part of each order which we may hereafter give to you, unless otherwise specified, and shall be valid until canceled by us in writing or revoked by the city or state.

 

Under penalties of perjury, the undersigned swears or affirms that the information on this form is true and correct as to every material matter.

 
 

By:*   

 

Title (Owner, Partner, Official):*    

 
 

I Agree

I Disagree

 

 

Online Customer Application - Personal Guarantee (Optional)

 

I,   , residing at  
Social Security #:   E-Mail Address: , for good and valuable consideration, including the extension of credit which I hereby acknowledge as having been received, do hereby personally guarantee and promise to pay any obligation to Comvox Systems Inc. and its affiliates, divisions, subsidiaries, and assigns ("Comvox Systems") on demand for any for any indebtedness of , to Comvox Systems which may become due.

 

This guarantee shall be a continuing and irrevocable guarantee and indemnity to Comvox Systems.  Further, I hereby subrogate any indebtedness of which it may have to me to the indebtedness of Comvox Systems.

 

I do hereby waive notice of default, non-payment and notice thereof and to jury trial and consent to all renewals and modifications of extension of credit.  The guarantor grants permission to Comvox Systems to obtain information from any and all sources required to properly ascertain the guarantor's capability to meet its financial obligations.

I hereby acknowledge and agree that by entering my name in the specified field and submitting this guarantee, I intend for such actions to constitute my signature, to conduct this transaction electronically, and to be bound by the terms and conditions provided herein.

I Agree

I Disagree

 

*** Please fax personal financial statements and tax return of guarantor to 904-309-6301 ***


You may attach up to 2 documents:

      
     



 

 

                     

 

Online Customer Application - Signature Agreement

* denotes a required field

     

 


By signing this application Applicant hereby acknowledges that it is submitting this Application to Comvox Systems LLC. and each of its subsidiaries and/or affiliates.  Applicant hereby gives the right to each of Comvox Systems LLC. and its subsidiaries and affiliates to rely on this application in consideration for the extension of trade credit at any time.  Applicant's authorized signature constitutes a representation of the trust and accuracy of all statements made on this Application and its express agreement to abide by the  Terms and Conditions of Sale.By entering his or her name in the specified field and submitting this application such authorized representative intends for such actions to constitute his or her signature, to conduct this transaction electronically.

 

Authorized Individual:*    Title:* 

Authorized E-Mail Address*    Date:*  

In regards to the agreement terms above:* 

I Agree

I Disagree

 

Please indicate if you authorize Comvox Systems LLC and its affiliates to communicate with your company via fax and email:*

Yes

No

 


   Full Name:
*  Email Address:
   Company Name:
   Phone Number:
   Order Number:
   RMA Number:
*  Details:
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